Blood Glucose Targets
The Diabetes Canada Clinical Practice Guidelines (2018)¹ recommend the following general guidelines for targets for glycemic control (blood sugar targets) for children and adolescents:
Glucose Targets - 2018 Canadian Clinical Practice Guidelines
| under 18 | ≤7.5 | 4.0 – 8.0 | 5.0 - 10.0 | Caution is required to minimize severe or excessive hypoglycemia. Consider preprandial targets of 6.0–10.0 mmol/L as well as higher A1C targets in children and adolescents who have had severe or excessive hypoglycemia or have hypoglycemia unawareness. |
A1C, glycated hemoglobin; PG, plasma glucose
In previous editions of the Clinical Practice Guidelines, different glucose targets were recommended for different age groups: higher targets for younger children, with tighter management as children grew through the school years and into the teens. (See below, A Look Back: Previous Glucose Targets, 2013 Clinical Practice Guidelines2)
However, changes were made in 2018 to reflect the results of new research which showed that an A1C of 7.5% or less can be safely achieved without an increase in the risk of severe hypoglycemia in children less than 6 years of age. The pre- and post-meal glucose targets were adjusted to reflect this change. The glycemic targets now apply to all children and teens under 18 years old, with adjustments to targets made on an individual basis (based on things like hypoglycemic awareness).
A Look Back: Previous Glucose Targets, 2013 Clinical Practice Guidelines
| <6 | <8.0 | 6.0 – 10.0 | – | Extra caution is required to minimize hypoglycemia |
| 6-12 | ≤7.5 | 4.0 – 10.0 | – | Targets should be graduated to the child’s age |
| 13-18 | ≤ 7.0 | 4.0 – 7.0 | 5.0 – 10.0 | Appropriate for most adolescents |
ISPAD Glycemic Targets
The International Society for Pediatric and Adolescent Diabetes (ISPAD) also provides guidelines for glycemic targets.
Similar to the Canadian guidelines, the ISPAD Clinical Practice Consensus Guidelines (2018)3 have evolved to focus on individualizing blood glucose and glycemic targets;, which apply for children, adolescents, and young adults up to age 25. They now recommend “individualized targets, aiming for the lowest achievable HbA1c without undue exposure to severe hypoglycemia balanced with quality of life and burden of care,” with an HbA1c of less than 7.0% as a benchmark target for most children/teens/young adults who have access to comprehensive care.
A higher HbA1c goal (still less than 7.5% in most cases) may be appropriate when a child cannot articulate their low symptoms, does not detect their lows (hypoglycemic unawareness), has a history of severe lows, or does not have access to: modern insulins; advanced insulin delivery technology (such as insulin pumps and CGM); technology and supplies to regularly check BG (blood glucose meters and test strips).
A lower goal (6.5%) may be appropriate if it can be achieved without excessive hypoglycemia, impairment of quality of life, and undue burden of care. A lower goal may also be appropriate during the honeymoon phase.
Following from this, glucose targets throughout the day should correspond with the individualized HbA1c target. For optimal glycemic control (for children and adolescents of all ages), ISPAD target guidelines are as follows:
| AM fasting or pre-meal BG | 4.0 - 7.0 |
| Post-meal | 5.0 – 10.0 |
| Bedtime | 4.4 – 7.8 |
Your child’s individual goals for blood glucose may differ from the numbers outlined above, depending upon a number of factors, such as: your child’s risk of low blood glucose; whether or not she recognizes a low; how long she has had diabetes; the presence of other medical concerns (related to diabetes or not); and the presence of any other challenges to optimal glycemic control (physical, developmental, psychological, family functioning, presence of others stressors, etc.). Consult with your child’s diabetes health care team to set targets for blood glucose control.
The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.
References:
Wherrett D, Ho J, Huot C, Legault L, Nakhla M, Rosolowsky E. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Type 1 Diabetes in Children and Adolescents. Can J Diabetes 2018; 42: S234–S246.
Diane Wherrett et al. Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Type 1 Diabetes in Children and Adolescents. Can J Diabetes 2013;37(suppl 1):S154.
DiMeglio, LA, et al. ISPAD Clinical Practice Consensus Guidelines 2018. Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes. Pediatric Diabetes October 2018: 19 (Suppl. 27): 105-114.
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